Special Olympics Ontario - Missed Payment Processing Form Thank you again for your support of Special Olympics Ontario. We do apologize for the inconvenience due to this discrepancy with PayPal's connection. Per our previous discussions, please see below the details of your original submission - after reviewing these details, click Submit to be taken to PayPal's site to complete the payment. We apologize for the inconvenienceIf you have been directed to this page it is because our payment processing system failed to collect your donation or payment for a Special Olympics Ontario or Torch Run Program, Event or Fundraiser. The information in this form should be pre-populated based on our records. Please update the information as required and click submit at the bottom of the form to be taken to PayPal to complete the transaction. You DO NOT require a PayPal account and may select to pay with a credit card directly. If you have any questions about the information provided or would prefer to pay by telephone or through another method please indicate this at the bottom of the form. Once again we apologize for the inconvenience and thank you for your support of Special Olympics Ontario and the Law Enforcement Torch Run for Special Olympics Ontario.Personal InformationIf you received this form as a link from a Special Olympics Ontario staff member this information should be pre-populated. Please confirm the information provided is correct before continuing.Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email PhonePayment InformationThe information below should describe the program, event or item for which payment is currently outstanding. Please ensure that this matches your records.Program / Event / ProjectDate of original donation / purchaseDescriptionA brief description of what this payment was for:PriceTotal Amount Due Total DueThis is the total amount outstanding for the items outlined in the description above. $ 0.00 CAD How do you wish to pay?Please indicate how you wish to pay. You may elect to pay by Credit Card (through PayPal), by credit card over the phone with a member of our staff or by cheque via the mail.by Credit Card via PayPal (a PayPal account is not required)by Telephoneby Cheque (via mail)Cheque InformationIf paying by cheque please mail a cheque for the full amount due to: Special Olympics Ontario 65 Overlea Blvd. - Suite 200 Toronto, Ontario, Canada M4H 1P1 Please be sure to include the name of the Program / Event / Project listed above in the memo line.TelephoneIf paying by telephone you may do so immediately if you are on the phone with a member of our staff or you may elect to do so at a later time by calling us back. To pay by phone please call 416-447-8326 or toll free at 1-888-333-5515 ext. 279 Monday to Friday from 9am to 6pm and speak to Jason Hussak to complete payment over the phone.Credit CardPayment by Credit Card is processed through PayPal. You do not require a PayPal account to complete your transaction. Simply select the option for processing a credit card payment without an account to complete your payment. Clicking Submit on this form will take you directly to the PayPal Payment Gateway.CommentsThis field is for validation purposes and should be left unchanged.